Scalp-sparing total skin electron therapy in mycosis fungoides: Case report highlighting technique and outcome

Abstract

Among the classically described cutaneous T-cell lymphomas, mycosis fungoides (MF) is the most common. Patients typically present with pruritic patches or tumors of the skin. Prognosis relates to age, stage, and the presence of extracutaneous disease.1,2 Total skin electron therapy (TSET) has emerged as the single most effective targeted therapy for patients with MF. Historically, complete response rates improved with dose escalation from 8 Gy to 36 Gy. Also seen with dose escalation was an increase in toxicity including dry desquamation, skin erythema, alopecia, anhidrosis, and loss of fingernails.1,3 Therefore, more recent studies have focused on the impact of dose de-escalation on toxicity and response rates. A pooled analysis published by Hoppe et al. explored low-dose (12 Gy, 1 Gy per fraction) TSET for patients with stage IB to IIIA disease. Of the 33 evaluable patients, the majority experienced a rapid reduction of disease burden and minimal toxicities.1 Alopecia remains a common concern of patients preceding TSET. In the aforementioned study, 1 female patient with stage IIB